Explant Surgery

Breast Explant Surgery
5th World Consensus Conference on BIA-ALCL | April 20, 2024 | Rome, Italy The Breast Implant Safety Alliance (BISA Nonprofit) has a summary page of key points from the conference. 5th World Consensus Conference on BIA-ALCL: Recap and Major Takeaways [...] Read more...
The Ripple Effect – Owning my Disability Story and Advocating for Justice I was honored to be a speaker at the Breast Implant Illness Summit 2024 sharing my story of healing and hope to empower other women, their medical teams, and their families. I’m often told that I’m not ‘disabled’ because I’m not incapable, incompetent, or any other in-. No, I’m not any of those, but I do have Breast Implant Illness – a chronic illness that I was forced to hide for far too long due to the stigma and bias. Another engineering faculty challenged me to own my disability story to support our students, faculty, and colleagues with disabilities. Thank you, Kelly T!! Disability runs across all other identities and is the only minority group that anyone can join, at any time, through illness, injury, accident or aging. “We are your friends. We are your family. We are your colleagues. We are you, potentially one day.” -Jamie Shields at Disabled by Society (link opens in new tab) I am a frequent presenter on disability inclusion, the challenges of disclosure, and equitable access to STEM and Medicine (STEMM). I only recently decided to share the backstory on my own long journey with BII following my mastectomy and reconstruction with recalled textured saline implants. I hope that sharing my story empowers women to seek the support they need, because we are not alone, and OUR STORIES MATTER. Jennifer Cook – Director of BIA-ALCL Advocacy at Breast Implant Safety Alliance Jennifer shared her story at the Breast Implant Illness Summit 2024, as well. Jennifer is the Director of BIA-ALCL Advocacy at the Breast Implant Safety Alliance (BISA) (link opens in new tab). My doctor asked for a copy of Jennifer’s and my interviews to share with colleagues as the human face of BII and BIA-xxx cancers. Summit host Sarah Phillipe gave permission to host our videos here, as well, because, to quote BISA, Knowledge is Beautiful and Not Our Daughters. The Breast Implant Illness (BII) Summit was hosted by advocacy powerhouses Sarah Phillipe and Danielle Valoras. Sarah and Danielle have personal experience with BII and have guided hundreds of women to hope, healing, and wholeness on their own journeys. At the Summit, they were joined by the top researchers, doctors, functional medicine providers, advocates and allies in the field to empower women to navigate our own healing journeys. Even if you have never had breast implants, there is something for everyone in the Summit! Anyone who has ever had surgery, an injury, or scar will find the talks on fascia, scar therapy and functional approaches fascinating. Anyone with childhood, adult, or medical trauma or a significant injury or illness will learn practical approaches to healing and restoration. There is critical information for women to consider BEFORE explant surgery including choosing a surgeon, the type of explant surgery, preparing your body, and special considerations to optimize healing. The Breast Implant Illness Summit aired for free from August 18-23, 2024, but will still be available to purchase lifetime access until the next summit in 2025. Breast Implant Illness Summit 2024 – Schedule and Presenters (affiliate link – opens in new tab) [...] Read more...
If you have textured breast implants, the Allergan and McGhan textured breast implant recall can be alarming. Do not panic, but educate yourself. Both saline and silicone TEXTURED breast implants were recalled for their association with Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). If you do not know what type of implants you have, again don’t panic! Take action by contacting your implanting surgeon. Because surgeons are not required to keep your records forever, contact them as soon as possible. Ask if they registered your implants with the manufacturer and get a copy of all warranty and device information. If you have recalled textured breast implants (SILICONE OR SALINE) from Allergan or McGhan, don’t panic! Keep reading, be aware, stay informed, and be empowered to take charge of your own health. You may wish to begin researching breast explant options, because waiting lists for qualified surgeons are quite long. You may wish to discuss your case with a BIA-ALCL attorney, as well, to ensure that proper procedures are followed. FDA Textured Breast Implant Recall On July 24, 2019, the United States Food and Drug Administration (FDA) recommended that Allergan issue a voluntary TEXTURED breast implant recall. Textured breast implants have been associated with an increased risk of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).  The recall also includes textured tissue expanders used to create space for a breast implant during reconstruction. Textured implants from McGhan Medical are also included in the recall. BIA-ALCL is a relatively rare type of cancer affecting a small percentage of all women with breast implants. Because many women have breast implants with a smooth surface, which have NOT been linked to BIA-ALCL, the overall percentage of all women with implants diagnosed with BIA-ALCL is small. If you have textured implants, your risk of developing BIA-ALCL, while still small, is higher than the overall rate for all women with implants. A list of devices recalled in the United States from the FDA, can be found here (FDA, 2019c). FDA Breast Implant Removal Recommendations From the U.S. FDA website, “For patients who have no symptoms, removal of these or other types of breast implants is not recommended, due to the low risk of developing BIA-ALCL. However, if you have any questions, talk to your health care provider” (FDA, 2019b). There are surgical risks to explant surgery. At the time of this recommendation, the FDA felt that the risks of surgery were greater than the risk of BIA-ALCL, for women without symptoms. When did they know about the risks of Textured Breast Implants? The 2011 FDA Update on the Safety of Silicone Gel-Filled Breast Implants stated that “Women with breast implants may be more likely to be diagnosed with anaplastic large cell lymphoma (ALCL),” (Drugwatch, 2019b, FDA, 2011). Lawsuits against Allergan indicate that the company may have been aware of the risk years earlier, in the 1990’s (Drugwatch, 2019a). In March, 2019, the FDA heard two days of testimony from experts (link to FDA testimony video) in the breast implant field. But in May, 2019, declined to ask for a recall due to the low risk of BIA-ALCL.  In July, 2019, the FDA took the unusual action of asking Allergan to recall textured breast implants and tissue expanders after additional data was reviewed (Drugwatch, 2019c).  Typically, companies initiate a recall without the FDA forcing the issue. Regulatory agencies in other countries had previously recommended this action. France’s National Agency for Safety of Medicines and Health Products (ANSM) was the first to issue a ban. Allergan stopped selling textured breast implants in Europe in December, 2018. Allergan announced that it would recall and stop the sale of textured Biocell breast implants in Canada in May, 2019 (Physician’s Weekly, 2019). Breast Implant Recall Notices According to the FDA, Allergan mailed recall notices to women with the recalled breast implants in 3 separate notification campaigns (FDA 2019b).  I had a nurse from a plastic surgeon’s office tell me that because I did not receive a letter, my implants were not recalled. However, not all surgeons register breast implants when they are implanted.  Women change addresses regularly. And surgeons are not required to keep medical records forever. Not receiving a letter does NOT mean that your implants are not recalled. Find your medical device registration card- if you were given one. If not, call your implanting surgeon’s office and request a complete copy of your medical record. Breast Implant Recalls in the UK, Canada, and Australia In the United Kingdom, the UK.gov website shares guidance for patients and physicians (gov.UK, 2019). The UK government previously issued 3 Medical Device Alerts regarding the increased risk of BIA-ALCL in 2011, updated in 2014, and in 2019. Allergan’s Financial Impact from Breast Implant Recall Quoting financial analysis in the UK, Reuters speculated that a direct financial impact from the recall would be negligible for Allergan, which announced its sale to AbbVie, Inc. for $63 billion prior to the FDA recall (Reuters, 2019, Wall Street Journal, 2019). References Drugwatch. (2019a). Allergan Breast Implant Lawsuits. Retrieved from https://www.drugwatch.com/allergan-breast-implants/lawsuits/ Drugwatch. (2019b). Allergan breast implant recalls. Retrieved from https://www.drugwatch.com/allergan-breast-implants/recalls/ Drugwatch. (2019c). Allergan cites rare cancer as reason for breast implant recall. Retrieved from https://www.drugwatch.com/news/2019/07/30/allergan-cites-rare-cancer-breast-implant-recall/ Gov.UK (2019). Breast implants and Anaplastic Large Cell Lymphoma (ALCL): Information for clinicians and patients. Retrieved January 22, 2020, from https://www.gov.uk/guidance/breast-implants-and-anaplastic-large-cell-lymphoma-alcl#history Physician’s Weekly. (2019). Allergan to recall textured breast implants in Canada. Retrieved from https://www.physiciansweekly.com/allergan-to-recall-textured/ Reuters. (2019, July 24). Allergan recalls textured breast implants worldwide. Retrieved from https://uk.reuters.com/article/us-allergan-recall/allergan-recalls-textured-breast-implants-worldwide-idUKKCN1UJ1N9 U.S. Food and Drug Administration (FDA). (2019a). Allergan Recalls Natrelle Biocell Textured Breast Implants Due to Risk of BIA-ALCL Cancer. Retrieved from https://www.fda.gov/medical-devices/medical-device-recalls/allergan-recalls-natrelle-biocell-textured-breast-implants-due-risk-bia-alcl-cancer U.S. Food and Drug Administration (FDA). (2019b). Medical device recalls: Allergan. Retrieved 2020, January 22, from  https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRES/res.cfm?start_search=1&event_id=&productdescriptiontxt=&productcode=&IVDProducts=&rootCauseText=&recallstatus=&centerclassificationtypetext=&recallnumber=&postdatefrom=09%2F10%2F2019&postdateto=09%2F12%2F2019&productshortreasontxt=&firmlegalnam=Allergan&PMA_510K_Num=&pnumber=&knumber=&PAGENUM=500 U.S. Food and Drug Administration (FDA). (2019c). The FDA Requests Allergan Voluntarily Recall Natrelle BIOCELL Textured Breast Implants and Tissue Expanders from the Market to Protect Patients: FDA Safety Communication. Retrieved from https://www.fda.gov/medical-devices/safety-communications/fda-requests-allergan-voluntarily-recall-natrelle-biocell-textured-breast-implants-and-tissue#list Wall Street Journal. (2019, June 25). AbbVie Strikes Deal to Acquire Allergan for About $63 Billion: Drugmakers agree to one of the biggest mergers in the health sector this year. Retrieved from https://www.wsj.com/articles/abbvie-nears-deal-to-buy-allergan-for-more-than-60-billion-11561458504 [...] Read more...
Registered Nurse and Breast Implant Illness Survivor, Sarah Phillipe, shares in her YouTube video how BII is not JUST about the breast implants! Sarah Phillipe, of Reversing Breast Implant Illness, shares how breast implants are a contributing factor to Breast Implant Illness (BII). As Sarah explains, however, breast implants are not likely the one and only cause of BII symptoms. Like the analogy of the three legged stool, breast implants can be one leg or contributing factor. However, breast implants alone are generally only a piece of the puzzle that is Breast Implant Illness. We all have individual stories with the common factor of breast implants. We all arrived at this point in our lives with different exposures to mental and emotional stressors, physical stressors, and chemical or toxic exposures. For some women, breast implants can be the last drop that overflows our body’s bucket of toxicity. For others, breast implants can be the trigger that starts an autoimmune response and develops into BII over time. Sarah cautions about assuming that breast implants are the sole cause of our current health crisis. While explant surgery is an excellent choice, it might not be the miracle that brings about total healing. I am one of the women who has not had a miracle turnaround following explant. I found the following video to be encouraging, however. It is a reminder to be kind to ourselves in the process. Be empowered! You are not alone! Sarah has appeared on numerous podcasts and conferences. Check out the full list at BII Resources – Reversing Breast Implant Illness. Sarah Phillipe of Reversing Breast Implant Illness Additional Medical Device Cancers An interesting article that discusses additional medical devices known to cause cancer is An Update on Implant-Associated Malignancies and Their Biocompatability. Abstract: Implanted medical devices are widely used across various medical specialties for numerousapplications, ranging from cardiovascular supports to orthopedic prostheses and cosmetic enhancements.However, recent observations have raised concerns about the potential of these implants toinduce malignancies in the tissues surrounding them. There have been several case reports documentingthe occurrence of cancers adjacent to these devices, prompting a closer examination of theirsafety. This review delves into the epidemiology, clinical presentations, pathological findings, andhypothesized mechanisms of carcinogenesis related to implanted devices. It also explores how thesurgical domain and the intrinsic properties and biocompatibility of the implants might influencethe development of these rare but serious malignancies. Understanding these associations is crucialfor assessing the risks associated with the use of medical implants, and for developing strategies tomitigate potential adverse outcomes. Keane Tahmaseb, G. C., Keane, A. M., Foppiani, J. A., & Myckatyn, T. M. (2024). An update on implant-associated malignancies and their biocompatability. International Journal of Molecular Sciences, 25(4653). https://doi.org/10.3390/ijms25094653 [...] Read more...
Whether you are having a mastectomy, reconstruction, breast implants for any reason, or explant surgery, choosing a board-certified surgeon carefully can impact the rest of your life.  The decision to have surgery is emotional, physical, and financial.  Before deciding on which surgeon to entrust with your body, do your homework, ask questions, and take your time to get reliable answers.   It is important to consider both the surgeon’s qualifications and experience, but also understand the possible surgical options. Board Certification According to the American Society of Plastic Surgeons (ASPS), choosing a board-certified plastic surgeon is critical, no matter what country you choose for surgery. The Trust ASPS campaign shares the importance of thorough researching your surgical options and choosing a qualified plastic surgeon for the safest outcomes (ASPS, 2019). Both the ASPS and The American Board of Plastic Surgery provides a physician locator at their websites.  In Europe, check the European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) website for further information. American Society of Plastic Surgeons (ASPS) – also includes an international listing (https://find.plasticsurgery.org/)American Board of Plastic Surgery (https://www.abplasticsurgery.org/ModDefault?section=SurgeonSearch)Certification Matters – a grouping of multiple surgical specialties  https://www.certificationmatters.org/European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS) http://www.ebopras.org/index.phpThere is also a comprehensive international list of explant surgeons recommended by other patients and carefully vetted by the authors at the Breast Implant Illness website https://www.breastimplantillness.com/explant-surgeons/ Breast Explant Surgeons Communicate BEFORE surgery Surgeons who believe in Breast Implant Illness (BII) and understand that implant removal can cause serious health complications will be more attentive to your wishes and careful during explant.  Get the entire surgical plan in writing and read it carefully. Check references and talk to former patients.Read their website, patient literature, and fine print.Ask the right questions (risks, benefits, insurance, procedure, testing for BIA-ALCL, legal chain of custody, etc.).Keep asking questions until you get answers, even if the surgeon and staff become annoyed. Speak to an attorney before surgery to ensure that all procedures, paperwork, and testing is done properly.If you feel uncomfortable about any aspect of the surgery, go elsewhere. There are numerous horror stories on the Internet of women who thought they were having a total capsulectomy only to find out later that the surgeon drained the implant first or left part of the capsule.  One blogger is faced with her third surgery (paying out of pocket) to remove pieces of the capsule left behind by her surgeon.  En Bloc and Insurance There is a much smaller pool of surgeons with the training, expertise, and experience to properly do an En Bloc implant removal.  Although many websites state that these surgeons do not take insurance, this is not necessarily true.  My surgeons at Midwest Breast and Aesthetic Surgery in Columbus, Ohio, take many insurance plans and are experts in En Bloc surgery.  Refer to the list at Breast Implant Illness website, which despite some disgruntled doctors’ complaints, is an impartial review of qualified explant surgeons.  Even if you are paying for explant surgery out of pocket, it is extremely important to consider the expertise of the surgeon.  You may be able to travel for surgery and still pay less than you would with a lesser trained surgeon who may cause you to have further complications following explant surgery. References American Society of Plastic Surgeons (ASPS). “Trust ASPS: Choose a board-certified plastic surgeon”. Retrieved July 15, 2019, from https://www.plasticsurgery.org/patient-safety/trust-asps American Society of Plastic Surgeons (ASPS). “Is your surgeon certified?” Retrieved July 15, 2019, from https://find.plasticsurgery.org/ Breast Implant Illness. “Explant surgeons.” Retrieved July 15, 2019, from https://www.breastimplantillness.com/explant-surgeons/ Certification Matters. “Is my surgeon board-certified?” Retrieved July 15, 2019 from https://www.certificationmatters.org/ National Center for Health Research. “Your guide to breast implants and your health: We’re quoted.” Retrieved July 15, 2019, from http://breastimplantinfo.org/newsroom-2/were-quoted/ European Board of Plastic Reconstructive and Aesthetic Surgery (EBOPRAS). “Welcome.” Retrieved July 15, 2019, from http://www.ebopras.org/index.php [...] Read more...
Breast implant removal is commonly called ‘explanting the implant’, or explant for short. In the video below, Dr. Ergun Kocak (left) and Dr. Pankaj Tiwari (right), from Midwest Breast and Aesthetic Surgery, discuss the importance of removing the entire breast implant capsule during explant surgery. The doctors discuss the formation of biofilms, or as Dr. Kocak describes them, trenches where bacteria like to hide. This discussion applies to both saline and silicone implants! Shortly after a breast implant of any type is place in the body, scar tissue called a capsule, begins to form around the implant. If you have Breast Implant Illness, you MUST have the scar tissue capsule removed with the implant intact. In other words, the scar tissue that formed around the implant should be removed without being ruptured or drained. The gold standard for explant surgery is En Bloc, a specific type of total capulsectomy. En Bloc Total Capsulectomy Drs. Kocak and Tiwari are experts in the En Bloc breast implant removal procedure. En Bloc is a specific type of total capsulectomy, which removes both the implant and the entire tissue capsule intact. Breaking the capsule of scar tissue while it is still in your body releases toxins surrounding the implant. In En Bloc explant surgery, the capsule is removed without disrupting the implant. Do NOT allow your surgeon to drain the implants first or to remove the implant and then the remaining capsule. This exposes your body to toxins in the capsule and biofilms around the implant. The capsule of tissue and the implant should be removed together without rupturing the capsule. [...] Read more...
The following video on YouTube is testimony to the FDA by Dr. H Jae Chun, MD. Dr. Chun explains why he has chosen to focus his plastic surgery practice on explant breast implants. He shares his views on the conflicting information presented to sufferers of Breast Implant Illness (BII). If you have saline OR silicone implants with a variety of seemingly unrelated symptoms, please grab a cup of tea and be reassured that it is not in your head. If someone you love has implants, and you are wondering how to help, please listen in and reassure her that there is a solution. [...] Read more...
Know your EXPLANT TERMS!  Your recovery depends upon choosing the correct type of explant surgery and a skilled, licensed surgeon with experience. If you have any symptoms of Breast Implant Illness (BII), your health could actually get worse if you choose the wrong surgeon and wrong type of surgery.  For Breast Implant Illness sufferers, the ONLY safe option is En Bloc, a specific type of total capsulectomy.  Keep reading to learn the terms you need to memorize! Explant Terminology to Know There are three terms typically used in the language of explant surgery. It is extremely important to understand the differences, particularly in the case of Breast Implant Illness (BII). Capsule refers to the scar tissue your own body makes surrounding the breast implant.  Capsulotomy, Capsulectomy, and En Bloc implant removal all have important distinctions. CapsulOTomy The word ending -otomy means “to make an incision or cut into”.  Therefore, capsulotomy refers to removing part of the capsule of scar tissue surrounding a breast implant in order to make more space for the implant.  This is NOT the proper technique for explant surgery! This surgical technique is typically used to modify the scar capsule when capsular contracture has caused the capsule to shrink and harden around the implant.  See the separate post on capsular contracture for more information on causes and treatments. This technique is NOT appropriate for removal of implants in anyone, but particularly in the case of BII. Total CapsulECTomy Capsule refers to the scar tissue surrounding the breast implant.  In this case, however, -ectomy means “removal of an anatomical structure”.  TOTAL Capsulectomy is the removal of the entire capsule of scar tissue that surrounds the implant.  Beware: Total CapsulECTomy may not mean that the capsule is removed INTACT, which exposes your body to toxins! En Bloc implant removal is a particular type of total capsulectomy where the entire capsule is removed with the capsule intact! En Bloc is the only acceptable type of explant surgery for women with Breast Implant Illness. En Bloc Capsulectomy En Bloc is a French term (think ‘in’ ‘block’).  This specific surgery means the surgeon will remove the scar tissue surrounding the implant WITH THE IMPLANT STILL INTACT AND UNDISTURBED.  The scar tissue capsule should NOT be punctured during surgery.  En Bloc is the gold standard for any breast implants, either saline or silicone.  Removing the intact implant WITH the surrounding scar tissue prevents any chemicals, silicone, and bacteria from being released into your body.  If you have silicone implants, your implants are ruptured or leaking, or if your implants are very old, it is extremely important to contain the toxins within the capsule during removal. What’s the difference? Total capsulectomy can refer to removing the implant from the capsule FIRST, and then removing the remaining scar tissue that had surrounded the implant.  This will release any of the toxins in the capsule into your body.  It is extremely important to remove the scar tissue capsule completely. However, it is equally as important not to allow the toxins within the capsule surrounding the implant to be released into the body during surgery.  If you have had Breast Implant Illness (BII), you should be more specific than total capsulectomy and choose En Bloc if possible. Do NOT let your surgeon drain the implant or capsule before removal.  Yes, this is easier for the surgeon, but YOU will pay the health consequences. Not only would you be exposed to toxins surrounding the implant, but your surgeon should be aware of the possibility of BIA-ALCL. BIA-ALCL Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a type of lymphoma (cancer) associated with textured breast implants. BIA-ALCL is often accompanied by fluid surrounding the implant. See the Consensus Guidelines on the Diagnosis of BIA-ALCL, linked below. 2019-NCCN-Consensus-Guidelines-on-the-Diagnosis-of-BIA-ALCLDownload What about adhesions? If you have had your implants for more than a few weeks, your capsule may be adhered to the chest wall and your rib cage. Surgeons who are trained in the En Bloc procedures and experienced in performing the surgery know how to gently separate the intact capsule from ribs and muscles.  Understanding what your doctor plans to do if your capsule is adhered is crucial BEFORE you have surgery. Be sure to communicate your preferences before surgery, because your surgeon will need to make decisions while you are under anesthesia.  It is possible that your surgeon will find that your capsule is very thin or potentially adhered to the chest wall.  Even in these cases, with the understanding that en bloc removal is a high priority, your surgeon can work to remove the capsule without rupture (Feng, 2019; Chen, 2017). For more information refer to the video from Midwest Breast and Aesthetic Surgery on the importance of removing the entire capsule. Communicate BEFORE Surgery Be informed about explant options BEFORE having surgery. Educate yourself before meeting with a surgeon and take a list of questions to your appointment. Have a written plan that includes what might happen in case the surgeon has difficulty removing the entire breast implant capsule. Review the post on choosing a board-certified surgeon who believes in Breast Implant Illness. These doctors will be more careful about protecting your future health from the toxins inside capsules during explant surgery! If you have textured breast implants, which are part of the Allergan (and McGhan Medical) recall, ensure that your surgeons are aware BEFORE surgery. If you are not sure, be clear that you expect your implants to be analyzed and proper BIA-ALCL testing done if they are part of the recall. Request the legal chain of custody for your capsules and implants from the surgeon IN WRITING BEFORE surgery. Keep copies for your records. Be vocal and clear about your expectations. Be Your Own Advocate! I requested the legal chain of custody for my implants in writing before surgery. My surgeons did NOT request this information when the samples were sent to the pathology lab. My surgeon excuse was his opinion that there would never be a viable lawsuit related to breast implants. My surgeons also knew in advance that my textured McGhan breast implants and tissue expanders were both recalled, and I had significant clinical symptoms of BIA-ALCL. They still failed to follow the consensus guidelines for BIA-ALCL diagnosis. The visual inspection report on my capsules and implants had been sent to the surgeon’s office 3 days after surgery. The Physician’s Assistant finally read the report after my fifth request, a full month later. She declared that the report was “fine” and even then did not give me a copy. She failed to mention that proper BIA-ALCL testing had not been done, in spite of recalled implants and significant symptoms. Although my surgeon wrote in the surgical record that they sent my capsules to the pathology laboratory for CD-30 staining, they did NOT. When I asked yet again for the chain of custody on my implants, my surgeon admitted that he did not know where my implants and capsules were located or who did pathology testing on his patients. He was completely unaware that the pathology lab routinely destroys implants two weeks after release of the visual examination pathology report. I requested the legal chain of custody from the manager of the pathology laboratory. She could not provide the document, because the surgeon had failed to request it when sending the implants. It would be illegal to make it up later. In fact, my implants were found in the medical waste bin awaiting destruction. They should have been destroyed 5 weeks earlier, while the surgeon’s office was completely unaware and unconcerned. You MUST be your own advocate and follow up. I assumed that because my surgeon had glowing reviews about himself and his staff on their website that they were attending to details. I was disappointed to find that both he and his office staff belittled me as “an explanter” and harassed me about asking questions. In fact, my surgeon gathered the entire office staff together to make fun of me at my final appointment. His parting shot was that they “only ridicule some patients”. I am eternally grateful for both surgeons’ medical skills. I’d like to think that at some point he’ll realize that encouraging his staff to make fun of cancer patients recovering from yet another grueling surgery (who also pay their salary) is rude at best. And maybe they will all start paying attention to important details of patient care. If you are planning explant surgery, you may wish to speak to an attorney BEFORE surgery to ensure that all proper procedures are followed. And be your own advocate, even if the surgeon and his staff make fun of you. You owe it to yourself and your loved ones! References: Chen, C. M. (2017). “Implant removal.” Retrieved July 9, 2019, from http://constancechenmd.com/implant-removalClemens, M. W., Jacobsen, E. D., & Horwitz, S. M. (2019). 2019 NCCN consensus guidelines on the diagnosis and treatment of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Aesthetic Surgery Journal, Volume 39, Issue Supplement_1, March 2019, Pages S3–S13, https://doi.org/10.1093/asj/sjy331 Feng, L. J. (August 1, 2016). Breast implant removal: Basics (I) . Retrieved from https://youtu.be/V9EngrFPxp0Kita, N. and Very Well Health. “Capsulotomy in breast implant surgery overview.” Retrieved July 9, 2019, from https://www.verywellhealth.com/capsulotomy-plastic-surgery-procedure-2710117)National Center for Health Research. (2019). “Your guide to breast implants and your health: Finding a plastic surgeon to remove your implants.” Retrieved July 9, 2019, from http://breastimplantinfo.org/finding-plastic-surgeon-remove-implants/National Center for Health Research. (2019). “Your guide to breast implants and your health: We’re quoted.” Retrieved July 9, 2019, from http://breastimplantinfo.org/newsroom-2/were-quoted/The Free Dictionary by Farlex. “-ectomy.” Retrieved July 9, 2019, from https://medical-dictionary.thefreedictionary.com/-ectomyThe Free Dictionary by Farlex. “-otomy.” Retrieved July 9, 2019, from https://medical-dictionary.thefreedictionary.com/-otomy [...] Read more...